This proposal documents the contributions of the University of Virginia (UVA) to the NHLBI/NINDS sponsored Network for Cardiothoracic Surgical Investigations in Cardiovascular Medicine (Network) and supports participation of the site as a Core Clinical Center within the Network going forward. A Skills Development Program is included with this proposal. UVA performs 1,050 adult cardiovascular surgeries procedures annually which are available for recruitment as the highest priority for clinical research. Our team demonstrates innovative approaches to patient recruitment and retention for a wide variety of challenging cardiothoracic surgical trials. The UVA investigative group is led by Department Chairman Dr. Irving L. Kron, a cardiothoracic and vascular surgeon. He has served in multiple national leadership roles with NHLBI. NINDS funded Dr. Karen C. Johnston, a nationally recognized vascular certified neurologist with significant expertise in clinical trials, neuroprotection, and outcomes research, plays a key role for the site in the development and conduct of challenging clinical trials. During the first funding period of the Network, cardiothoracic surgeon Dr. Gorav Ailawadi played a key role in successful screening and recruitment for UVA, and provides innovative ideas for research hypotheses and trial development. Additionally, Dr. John Dent, a nationally known cardiologist, provides specific expertise in echocardiography as it applies to valvular heart disease. Interventional cardiologist Dr. Michael Ragosta, Director of the UVA Cardiac Catheterization Laboratory, rounds out the leadership team. Experienced Registered Nurse clinical coordinators provide trial management; and compliance records from previous Network trials document superior trial performance. This unique blend of cardiac surgery, stroke neurology/neurological outcomes, and cardiology guarantee that UVA will continue to make substantive contributions to the Network. Our specific aim: To describe the experience, expertise and collaborative nature at UVA, among Thoracic and Cardiovascular Surgery, Cardiology, Neurology, and Public Health Sciences, that will substantially contribute to the success of the Network for Cardiothoracic Surgical Investigations in Cardiovascular Medicine.